PHILADELPHIA - Since the Clean Air Act of 1970, America's air has gotten cleaner, but the American Lung Association's 2015 State of the Air report finds that 44 percent of the nation still lives where pollution levels are too often dangerous to breath.
That's more than 138 million Americans.
Enter the Obama administration's new rules on carbon pollution designed to cut emissions by 32 percent nationwide over the next 15 years. The American Lung Association's Janice Nolen, assistant vice president of National Policy, says people who live closest to dirty power plants have the most to gain from the Clean Energy Plan.
She remembers when the Northeast was often referred to as the tailpipe of the nation.
"We've done a great job at helping to clean up some of that so that places, when you get further out, are not as polluted as they once were," Nolen says. "But a lot of the states, like Pennsylvania, are areas where the pollution levels are higher than they should be already because of the pollution from power plants."
The National Black Chamber of Commerce maintains tougher pollution standards will be "especially severe" on African Americans and Hispanics. A report issued by the organization in June says the new pollution-cutting rules will destroy millions of jobs and more than double the cost of power and natural gas.
Nolen disagrees, explaining the Clean Energy Plan directly addresses the criticisms of the National Black Chamber of Commerce and other opponents.
"Under the plan as it's in place now, the requirements would be that we make sure that we're not harming lower-income neighborhoods," says Nolen. "Which means for the first time, they may actually get more cleanup than they would otherwise."
Joe Minott, executive director of the Clean Air Council, says while the state has cut carbon dioxide emissions by 15 percent over the last decade, the EPA's plan will allow Pennsylvania to, as he puts it, "finally get serious about slowing climate change."
Minott says climate change threatens children, the elderly and low income communities the most.
"This plan takes environmental justice seriously," he says. "Which is important, since six of Pennsylvania's seven coal-fired power plants are in areas where 30 percent of the low-income population lives within a three-mile radius of a power plant."
According to Minott, 11 Pennsylvania counties had failing grades for ozone smog pollution last year, with Philadelphia and Pittsburgh each suffering more than 30 code orange days, which alert residents to their city's poor air quality.
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A recent report examined how some rural Tennessee hospitals have managed to stay afloat despite financial challenges.
The report includes interviews from staff at five different rural hospitals, which range in size from 25 to 125 beds.
Judy Roitman, executive director of the Tennessee Health Care Campaign, said some of the hospitals are drowning in uncompensated care. She explained as part of their research, they did an interview with a CEO from a rural hospital in Kentucky who expressed the importance of Medicaid expansion.
"Kentucky has expanded its Medicaid program and Tennessee has not," Roitman pointed out. "He said that's the key to our stability is actually having the funds coming in to treat these patients. And the CEOs and others in Tennessee hospitals said it would make a huge difference to have that federal funding."
Roitman added the federal government is offering Tennessee a nine-to-one match. If Tennessee were to expand Medicaid, at least 330,000 people would gain access to coverage.
Roitman pointed out the report suggested further steps hospitals could take, including examining how they are reimbursed for services provided. She noted private insurance plans tend to provide the highest reimbursement rates, and said more funding is needed to support TennCare, which does not cover enough of the cost.
"TennCare is all managed by managed-care organizations," Roitman explained. "They negotiate with every hospital about how they're going to reimburse and the big hospitals have some leverage to demand better payment and the smaller hospitals are just, they're just not getting paid."
Roitman added the report credited strong community engagement and effective hospital leadership as key factors in staff retention. Robust management and maintaining an engaged workforce significantly affect a hospital's viability, according to the report.
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Medicare and Medicaid are key sources of health coverage for many Americans and some people qualify for assistance under both programs. With lagging enrollment for the unique plans, outreach efforts are underway.
According to KFF Health News, only about three in 10 people who qualify for Dual-Eligible Special Needs Plans were enrolled in 2021. Experts said the option is designed for people who need additional help because of disabilities, certain health conditions or their age.
Dr. Gina Williams, associate medical director for UnitedHealthcare, said the plans try to take a dynamic approach to serving those eligible.
"Everything from managing your wellness to managing your behavioral health needs and then everyday needs," Williams outlined. "It's kind of a more comprehensive package for people who need a little bit more support."
Everyday needs include meal benefits and bathroom safety devices. The National Council on Aging said D-SNPs aim to provide a more streamlined coordination of care because there is assistance in arranging the services. Wisconsin's enrollment numbers are similar to the national rate, at 28%.
Christine Huberty, lead benefit specialist and northern region supervising attorney for the Greater Wisconsin Agency on Aging Resources, said a tricky component of the plans is navigating provider network restrictions. A rural resident might have to travel farther to see a doctor covered under the plan and she cautioned it warrants careful research when enrolling.
"I would say first and foremost, look at the provider network restrictions," Huberty advised. "Look at what's available in your area."
Meanwhile, Williams noted the push to get more eligible people to sign up coincides with more awareness around preventive care in a post-pandemic world.
"Everybody's kind of going into a phase where they're not only thinking about acute illness, but they're thinking about overall care," Williams observed. "What was the impact of the pandemic from a psychological standpoint? Do you need more support and then you also need more coordination of benefits?"
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In Mississippi and across the country, Community Health Centers are getting a funding increase, thanks to Congress passing a bipartisan spending package.
Community Health Centers in Mississippi serve patients without regard to their insurance status or ability to pay. More than 20 locations in the state provide medical care to more than more than 380,000 people.
Joe Dunn, senior vice president of public policy and advocacy for the National Association of Community Health Centers, said roughly one in 11 Americans gets their care from this type of clinic.
"Community Health Centers are the largest primary care network in the nation, providing care for 31 million Americans," Dunn pointed out. "This network is critically important, because they provide primary care, behavioral health, dental; just an array of services that are so critically needed."
Dunn emphasized more can be done. Research shows more than 100 million Americans need better access to primary care. Community Health Centers in Mississippi also support more than 4,000 jobs and about $678 million dollars in economic activity in the communities where they're located.
Dunn noted the increased funding from Congress will help the clinics provide more comprehensive care and reach more underserved patients, especially in rural communities, which ends up saving the state money.
"By incentivizing people to go get primary care, you alleviate more downstream costs," Dunn emphasized. "There's fewer hospitalizations and complications from chronic conditions, based on preventive screening and care at the outset."
The Congressional Budget Office reports the increase in funding for Community Health Centers just through the end of this year will reduce federal spending on public health insurance programs by more than $700 million.
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